Ovaries? Keep or not? Why or why not?

I'm attempting to resolve what has got to be the-decision-from-he** ... whether my abdominal hyst on Feb. 28 should also include removal of my ovaries.

I've been reading about it, both on this site and elsewhere, and in three books I have. I also tried to do a search on this site but since ovaries is a commonly term, so I came up with hundreds of mostly unrelated results. *sigh!*

To summarize a lot of input, the conflicting positions seem to be:

1. From my gyno: Remove. I'm 49, two years from average age of menopause at 51. Therefore I have roughly two more years of hormones from ovaries, after which they become a significant site for serious disease, including ovarian cancer. HRT can compensate for lack of hormones.
Also among those advocating removal are anyone who has been in any contact with ovarian cancer -- which is a truly horrific 'silent' killer -- and those who had problems with ovaries following a hyst, which appears to occur with some frequency.
The major risks of earlier menopause -- heart disease, stroke and osteosporosis -- can be countered in part by a healthy lifestyle.
Not much counters ovarian cancer. Often it is not diagnosed until it is too late.

2. Books/Articles/Opinions: Keep. Some studies suggest that the ovaries continue to have some hormonal function for up to 10 years after menopause, providing increased protection against stroke, heart disease and osteosporosis.
Ovarian cancer is relatively rare, striking approximately 1/87 women. There appears to be a strong genetic predisposition and there is some suggestion that a screening method will be developed in the next few years.
HRT is not a perfect solution since it cannot perfectly mimic the body's natural hormones and may create other risks. In addition, the body may not like being thrown into immediate menopause -- leaving aside what I may think of suddenly becoming officially "old."

3. A percentage of ovaries do fail following a hysterectomy, which means keeping the risks without the benefits. But I don't know how common or predictable this may be.

4. My family health risk history leans more strongly towards heart disease and stroke than cancer ... as far as I know although I'm not in contact with some cousins. My dad had his first heart attack at 68 and my grandmother died of a stroke at 84 (although she also had just-diagnosed colon cancer at the time as well.) Physically -- and I suspect genetically -- I am a carbon copy of my dad and his mother.

My hyst is due to a flourishing fibroid farm and an oversized five-month uterus. I've never had an abnormal pap smear or experienced any problems with my ovaries. My periods have always been ridiculously regular and continue so, albeit lighter now than they were and very occassionally with a slightly shortened cycle between "visits" from Aunt Flo.

I realize this is a very personal decision with no right or wrong answer. Since it is so important, I'm trying to make the right decision for me.

I'd greatly appreciate some real-life feedback from women who've been there. Did you keep your ovaries? Did they continue to function? Why did you choose that option?
OR
Did you have your ovaries removed? Why did you choose that option? Are you on HRT? How is it working?

Many thanks and keep well,
IslandScribe

That is indeed a very tough decision. I'm 47 and my doctor told me that if I were younger he'd say keep them and if I were older he'd say remove them. So I was faced with the same choice. I decided to keep my ovaries and the reasons were this:

1. I had not had any real trouble with them. The reason for my LSH was because of severe bleeding from fibroids.

2. No familiy history of ovarian cancer, but a family history of strokes and heart attacks.

3. I had gone through chemical menopause since I had a 3 month shot of Lupron prior to my LSH and while this menopause wasn't as bad as some people experience, it wasn't exactly fun. I didn't want to experience the sudden onset of menopause by losing my ovaries.

4. A good friend of mine just finished a year of h*** because of breast cancer that was caused by HRT after her hysterectomy 5 years ago. Luckily she's doing well now, but taking HRT scares me!

5. I felt that if my ovaries did fail after my LSH, that at least I'd still have some residual hormones that they say may occur for up to 10 years after menopause. Better than none at all.

Granted I had my LSH in early December so it may be too early to say what will happen with my ovaries, but as far as I can tell my ovaries are working as well as they did prior to surgery. I have experienced ovalation (sp?) twice since my surgery or at least my usual signs of it.

So that's my story and I hope it helps you in coming to a decision. Feel free to ask me any other questions that may help.

Hi Islandscribe,

I have a very similar background to Barblyn. I was 46 at the time of my surgery and I did (3) months of lupron shots to shrink my fibroids enough for my LSH. I also expereinced chemical menopause from the lupron. Hot flashes, night sweats and I lost interest in sex. I decided then that since ovarian cancer does not run in my family that I would keep my ovaries since I was a candidate. I had also read that ovarian cancer runs in about 5% of women so I felt I had good odds.

I am 10 months post-op now and my ovaries are working great. I get mild PMS each month. Sore breasts and some irritablity. My mom went through menopause at 51 so I feel I have a good chance until then.

I have read on H.S. that two reasons to go back for post-op surgery to remove the ovaries is endo and cysts. I also read that ovaries can go to "sleep" for awhile in post-op. I did not experience that. I stopped having menopausel symptoms from lupron right before my surgery.

Best wishes,

Mary

I haven't had my surgery yet, but I will be having a TAH with everything out. I haven't had any problems yet with my ovaries, but all the women in my family have had problems. My youngest daughter had to have one removed at the age of 21 and my oldest (who is 29 now) has PCOS. I decided I didn't want to chance any problems down the road. I just turned 48 in December.

I think this is a decision that only you can make.

Hang in there,
jas

At 45, I would love to have my ovaries out and just take HRT, but unfortunately I had a benign brain tumor (meningioma) and they are known to grow in response to female hormones. I had it fully removed 4 years ago, but they can recur and even with full resection many microscopic tumor cells are left behind. No way would I chance another one by taking hormones. I will leave my ovaries and wait for natural menopause a few years down the road. Plus, everyone in my family dies from stroke or heart attack, cancer is very rare.

IslandScribe - you're wise to take such a measured and considerate approach to your own health.

You've brought up some good points as well on both sides.

First, your doctor's recommendation for prophylactic oophorectomy is outdated. The American College of Gynecologist no longer recommends removal of ovaries in women over 45 unless there is a strong family history of cancers and a positive on the BRCA1 & BRCA2 tests.

Your risk of ovarian cancer decreases with each year that you don't develop it. So a young woman may have a 1 in 70 chance and a woman who reaches natural menopause would have a 1 in 100 chance. Having a hysterectomy further reduces the risk to 1 in 300. Other factors such as pregnancy, breast feeding and long-term birth control use can also reduce your overall risk.

Your ovaries are part of your endocrine system and work in balance with all of your other systems. There is no magic pill to replace this because each woman is her own unique cocktail. If they're not diseased, what can the reason be to take them out? You're far more likely to get breast cancer, but few women have prophylactic mastectomies - so why do we toss off our ovaries so easily? Since you have some time before you surgery, take some time to consult with a genetic counselor to truly assess your risks.

A hysterectomy or oophorectomy is no cure for PCOS or endometriosis - so there are patients who do later have further surgeries for these problems. If your major complaint is for fibroids, there is usually no involvement with the ovaries. If you suspect you have problems with cysts, you should consult a reproductive endocrinologist to be fully tested for insulin resistance, which is often the root cause of recurrent cysts and other hormonal imbalances.

There is a chance that the surgery will compromise your ovaries though, and there's no way to know whether it will happen or how long they will function fully. There are many studies and they often give conflicting information - some say menopause occurs four years earlier than normal, others say menopause comes five years after surgery. Some say that 10% of women who have a hysterectomy will experience ovarian failure within a year. It's hard to compare all of this data because women have hysterectomies for such different reasons, and the surgeries are performed in different ways.

My family has only a history of heart disease, alzheimers and strokes, so the choice was simple for me. Though most of the women have cysts, I'm willing to take that chance (I've never known to be disturbed by them). Besides, I was only 38 at the time and need those hormones as long as I can keep them. My older sister had a hyster more than five years before mine (for adenomyosis and uncontrolled bleeding) and her ovaries are still functioning normally.

I wish you the best.

Take care.

Rational for Ovarian Consevation by Donna Shoupe MD

This is the best article on the subject I have found. The main problem seems to be the lack of research on just what the ovaries do and how they do it after menopause. I have seen two studies that looked at the ovaries in the lab and concluded they do nothing. The Rancho Bernardo studies show that ladies 20- 30 years out from having their ovaries removed have lower levels of androgens and estrogens and higher risk factors for cardiovascular disease even when on ERT. It seems to me that the mantra of medicine has been to remove, in spite of not really knowing the potential harm.

If you keep your ovaries (and I wish I had kept mine) you can do what you will have to do if you take them out--Annual pelvic exam. You can still get ovarian cancer if they are removed. They call it peritoneal cancer then.

I was fortunate in that I did go though 9 months of a natural menopause. I was clearly not "done" with my ovaries at the time of surgery. Based on my experience I would recommend the natural route. You can always supplement mother nature if you need to.

My dr encouraged me to keep my ovaries. I was 51 at the time of my surgery and menopause was no where in sight. There's no family history of cancer or any other problems. I'm so glad he suggest I keep them. They are still plugging along and doing fine and hopefully will keep going for a long time.

This is one topic that each of us has to decide for ourselves and it's usually not easy. We're all different and have different histories to consider.

You're doing a good job of researching and finding what's best for you....keep up the good work.

Sending s and prayers that you can come to a decision you can feel comfortable with.

Blessings,
Judy

Hi IslandScribe, I understand how you feel and like you I did much research and came away with the conclusion the decision to remove the ovaries or not is really a personal decision. I'm 49 and am in Perri-menopause (spelling?). I've had 1 menstrual cycle in the past 8 months, had mild hot flashes, insomnia, etc. My family history is mostly heart disease but low incidence of cancer. My doctor suggested I have my ovaries removed. I am scheduled for a TVH with bladder and rectal repairs due to prolapse of uterus, bladder and rectum; I go in for surgery 2/25/05. I have agonized over this decision and even though I have basically made up my mind to have them removed, I still wonder if this is the right decision. I believe it is for me; it's just a gut feeling that I should. Only you can make that final decision and it comes from deep within you. I send my strength and prayers to you as you work through this personal decision. No matter what you decide, there is no right or wrong. Thank goodness we all have the precious gift of the freedom to choose. We are with you and you are not alone! Take care, Diane

My gyn neither encouraged nor discouraged me from retaining my ovaries when I had my surgery at the age of 50. I decided to ditch mine because:

• 1. Cancer runs in my family - not ovarian cancer (yet!), but other cancers ranging from leukemia to uterine cancer to melanoma to cervical cancer.
  2. No relatives of mine have had heart disease.
  3. My personal extreme terror of getting OvCa, no matter how low of statistics cited in books and articles, because of a friend dying from it and seeing her extreme suffering.

Like Diane, mine really came down to a "gut" decision. I have had my share of struggles with surgical menopause, but I am nevertheless at peace with my decision. I think it was the best choice for me. I hope you make the best decision for you!

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